Estimating treatment importance in multidrug-resistant tuberculosis using Targeted Learning : an observational individual patient data network meta-analysis

Persons with multidrug‐resistant tuberculosis (MDR‐TB) have a disease resulting from a strain of tuberculosis (TB) that does not respond to at least isoniazid and rifampicin, the two most effective anti‐TB drugs. MDR‐TB is always treated with multiple antimicrobial agents. Our data consist of individual patient data from 31 international observational studies with varying prescription practices, access to medications, and distributions of antibiotic resistance. In this study, we develop identifiability criteria for the estimation of a global treatment importance metric in the context where not all medications are observed in all studies. With stronger causal assumptions, this treatment importance metric can be interpreted as the effect of adding a medication to the existing treatments. We then use this metric to rank 15 observed antimicrobial agents in terms of their estimated add‐on value. Using the concept of transportability, we propose an implementation of targeted maximum likelihood estimation, a doubly robust and locally efficient plug‐in estimator, to estimate the treatment importance metric. A clustered sandwich estimator is adopted to compute variance estimates and produce confidence intervals. Simulation studies are conducted to assess the performance of our estimator, verify the double robustness property, and assess the appropriateness of the variance estimation approach

Mycobacterium Bovis infection in children in the same family: transmission through inhalation

Two children in the same family were infected with Mycobacterium bovis (“M. bovis”). The molecular typing showed an identical source of infection. Althoughon school of thought was that the route of transmission was by ingestion of contaminated dairy milk, in other it was thought to be by air-borne transmission. The presentation highlighted the possibility of M. bovis infection in the pediatrics populations through aerosols

Primary multi-drug resistant tuberculosis presented as lymphadenitis in a patient without HIV infection

Primary multi-drug resistant extrapulmonary tuberculosis is an uncommon form of the disease, but it seems that by increasing the number drug resistant tuberculosis around the world, the number of cases of primary multidrug resistant tuberculosis with extrapulmonary presentation also is going to rise. In this report, we describe a 19- year old, HIV negative man with primary multi-drug resistant TB lymphadenitis, presented with cervical lymphadenopathy and sinus discharge at the site of involved lymph nodes. The Acid Fast Bacilli (AFB) smear of sputum was negative but the AFB smear of discharged fluid as well as the excisional biopsy of the lymph nodes confirmed the M. tuberculosis infection. The patient underwent the treatment with a combination of isoniazide, clofazimine, pyrazinamide, ofloxacin and amikacin with promising results. By increasing the number of drug resistant tuberculosis patients around the world, appropriate diagnosis and treatment of different presentations of the disease need a special attention

Load characteristics, in vitro bioaccessibility and health risk assessment of PM2.5–bounded heavy metals in indoor air of waterpipe and/ or cigarette cafes compared to smoking-free cafes

Samples of PM2.5 particulates were collected from indoor air of 36 cafés, 14 cafés in which only water pipe (WS) was used, eight in which only cigarette was smoked (CC), six in which both waterpipe and cigarette were smoked (WCC), and eight cafés in which no smoking occurred (SFC) in Tehran. After that, the concentration of lead (Pb), cadmium (Cd), nickel(Ni), and chromium (Cr) was examined by atomic absorption spectrophotometer (AAS) (GF 5000, Australia). The results indicated that the ƩMetal concentration (Mean ±SD) in WCC, WC, CC, and SFC cafés were 1118.5±50.42, 663.64±40.79, 425.57±17.55, and 79.02±5.13 ng/m3, respectively. The mean bioaccessibility of Pb, Cr, Ni, and Cd was obtained as 39.7, 31.4, 7.35, and 74.6, respectively. The results of risk assessment indicated that exposure to heavy metals in the indoor air of smoking cafés of Tehran is considered high. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Pulmonary Mycobacterium Simiae infection and HTLV1 infection: an incidental co-infection or a predisposing factor?

There is little information on atypical mycobacterium and human T lymphothropic virus Type I (HTLV-I) co-infection. We present the first case of pulmonary M. simiae infection in co-infection with HTLV-1, confirmed by ELISA antibody test and Western Blot. We discuss the clinical characteristics and laboratory tests of the patient and presumptive immunological relation. We propose that in patients with the HTLV infection and pulmonary symptoms and signs compatible with tuberculosis, evaluation for atypical mycobacteriosis may be recommendable

ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle

The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma a

Biomonitoring of unmetabolized polycyclic aromatic hydrocarbons (PAHs) in urine of waterpipe/cigarette café workers

Fresh tobacco or the smoke resulting from waterpipe and cigarette contains large amounts of polycyclic aromatic hydrocarbons (PAHs), which consumption can cause releasing of these contaminants into the indoor air of cigarette and waterpipe cafés. This study was conducted to investigate the urinary concentrations of unmetabolized PAH compounds among the employed workers as well as the customers in waterpipe and cigarette cafés along with its association with oxidative stress factors plus kidney injury biomarkers. For this, 35 staffs and 35 customers in these cafés (as an exposed group (EG)), 20 staffs in non-smoking cafés (as 1st control group (CG-1)), and 20 of the public population (as 2nd control group 2 (CG-2)) were chosen and their urine specimens were collected. The results indicated that there is a significant difference between urinary concentration of ƩPAHs in the exposed and control groups (P value < 0.05). Also, “type of tobacco” can be considered as an influential and determining factor for the urinary levels of PAHs among the subjects. Considering the contribution of PAHs to the total toxic equivalents, benzo[a]pyrene (BaP), dibenzo[a,h]anthracene (DahA), and fluoranthene (Flrt) with 32.76%, 27.62%, and 18.65% claimed the largest share in waterpipe/cigarette cafés. The results also indicated a positive and significant relationship between some PAHs and oxidative stress biomarkers as well as uKIM-1 (biomarker for assessing and diagnosing glomerular damage) and TIMP-1 (biomarker of stress in primary steps of injury in tubular cell). Thus, it can be expressed that the workers of these smoking cafés are prone to the detrimental health impacts. Accordingly, proper policies and decisions should be taken to limit the activity of these cafés or proper protective strategies should be adopted to protect the health of exposed individuals. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature

Carbon monoxide in exhaled air of students in Tehran

Background and aimsCarbon monoxide poisoning is a major cause of mortality due to gasinhalation. It is more prevalent in winter, because of poor indoor ventilation. The purpose of ourstudy was to evaluate exhaled carbon monoxide of students and to estimate their exposure to this gas.MethodsThis cross-sectional study was performed in winter 2008. The exhaled carbonmonoxide level of 184 students was assessed by breath analyzer. Questionnaire data werecollected to assess smoking habit, types of domestic exposures and symptoms of carbon monoxide  intoxication.ResultsStudents consists of 79 boys and 105 girls. Number of cases in carbon monoxide levelsof 0-6 ppm, 7-10ppm, 11-20ppm and above 20ppm were consecutively 150(81.52%),23(12.50%), 10(5.43%) and 1(0.54%). The difference of symptoms in different groups was not  significant.ConclusionDue to our results, 34(18.47%) cases of healthy nonsmoker students had abnormalexhaled carbon monoxide level of more than 1-3 ppm which could be attributed to environmentalexposures. 11(5.97%) cases had carbon monoxide exhaled level of more than 11ppm whichexceeds the permissible exposure limits. More attention should be paid to the sources of carbonmonoxide exposure in children, in order to minimize morbidity and mortality related to carbonmonoxide intoxication

Polycyclic aromatic hydrocarbon (PAH) leachates from post-consumption waterpipe tobacco waste (PWTW) into aquatic environment- a primary study

Post-consumption waterpipe tobacco waste (PWTW) is an unrecognized type of hazardous waste that is produced and released in large quantities into the aquatic environment. It may contain high amounts of various pollutants including PAH, and to date, there has been no research on the potential for contamination by PAH from PWTW leaching into aquatic environments. In this study, the concentrations of PAH via PWTW of fruit-flavored and traditional tobacco leachate into three water types, including distilled water (DW), tap water (TW) and sea water (SW) at different contact times were evaluated. There were significantly higher concentration levels of ƩPAH in waters with leachates from fruit-flavored PWTW than traditional tobacco (P-value<0.05). The concentration levels of ƩPAH in DW, TW and SW at a total contact time of two months ranged from 0.13 to 3.51, 0.12 to 3.63 and 0.11–3.64 μg/L, respectively. Lower molecular weight PAH such as naphthalene (Naph), acenaphthylene (Acen) and fluorine (Flu) were detected in leachates immediately after a short contact time of 15 min. Higher molecular weight PAH including benzo [a]anthracene (BaA), benzo [b]fluoranthene (BbF), benzo [k]fluoranthene (BkF), chrysene (Chr), and benzo [a]pyrene (BaP) were detected after one month contact time, while indeno [1,2,3-cd] pyrene (Indp), benzo [ghi]perylene (BghiP) and dibenz [a,h]anthracene (DahA) were only observed at the contact time measurement of two months. By adding sodium azide as an antimicrobial agent and chemical preservative to SW samples, higher concentrations of PAH including IP, DahA and BghiP were observed. The concentration levels of PAH in water samples after two months contact time were higher than water quality standards provided by the World Health Organization (WHO) and other international organizations. © 2023 Elsevier Lt